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    December 24, 1853] T HE LEA DE R. 1241. ...

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    Noble On Insanity. Elements Of Psycholog...

    latter are discovered , with large quantities of the white , fibrous substance interposed . There is all the certainty that is attainable upon such a subject , that the several ganglionic asses in the encephalon subserve different functions , and that the office of the white matt 5 s to bring these ' masses into mutual relation and harmonious action . " We now pass to what is questionable . Having described the vesicular neurin ' e , o * nerve-cells . Dr . Noble say _ s : — " . " Althoug h not actually demonstrated , it is yet a tolerably certain inference , that , districted largely and very minutely along the whole cutaneous and mucous surfaces , there is -flicular neurine ; this forms the peri p heral expansion of nervous filaments , and may be rkened to the structure of the refcina as it expands itself behind the vitreous humour . " So far from this being a tolerably certain inference , we have no hesitation in saying that it is an hypothesis quite ahead of all present knowledge , and not corresp onding with what anatomy has discovered up to this time . It may turn out to be true ^ meanwhile , the facts to justify it are wanting . No one has dabbled in the literature of the nervous system without being aware of the vexata qiusstio of the peripheral termination of nerves ; and we are at i loss to conceive where Dr . Noble found authorities for the following

    hypo-» The nerves and ganglia of the five external senses constitute the instruments whereby the primary and more simple forms of consciousness display themselves . Vesicular neurine distributed upon the lining membrane of the nostrils possesses a specific sensibility to odorous matters ; the impression which these make is conveyed by conducting fibrous filaments to the bvlbi olfactorii—the ganglionic centres wherein the sense of smell is called \ Jto exercise . The retina is composed of vesicular neurine ; visual impressions are carried alonSC the course of the optic nerves , and attain the corpora quadrigemina , which there is every reason for concluding to be the ganglia of sight . Vesicular neurine , spread largely within the internal ear , receives the vibratory undulations constituting the external cause of sound the fibrous filaments of the auditory nerve conduct the influence to certain grey nuclei in the posterior pyramids of the medulla oblongata , that form the ganglia of hearing . The vesicular termination of nervous filaments upon the lingual surface and the palate are cr «> f . ; fina 11 v impressed by sapid particles , and the impression being passed along fibrous filaments to the proper ganglionic centre Qyet undetermined ) , induces the consciousness ot out to be truebut what is alread

    As before hinted , this may turn ; y known is insufficient , we believe , to justify it . Dr . Noble speaks of , " vesicular neurine distributed upon the lining membranes of the nostrils . " Who has over seen it there ? Dr . Carpenter , whom he seems to be following , suggests that " perhaps" it may be there ; but in anatomy , " perhaps" will not do . Dr . Noble further says , that the retina is " composed of vesicular neurine . " If this be not a very vague use of the term , we must altogether deny it . A reference to Kolliker , Handbuch der Gewebelehre , p . 607 , will inform him of what is known , and what is hypothetical on the structure of the retina . And as to ' 'taste , the . nerve-cells terminating the nerves of the tongue , have not even been suspected . . .. Having made this necessary criticism on an hypothesis presented as " tolerably certain , " we continue Dr . Noble ' s exposition : —

    " But there is developed a sense-consciousness which is not limited to any particular organ , but which may be said to pervade the entire fabric ; it comprehends that general sensibility which resides principally in the cutaneous and mucous surfaces , and , to a less extent , the interior structures . It is by it we appreciate the state of the muscles , —obtain the muscular sense , as it has been called . This ' common sensation'is best illustrated by the simple notion of resistance . Its various modifications comprise the several impressions essential to ideas of the hard , the soft , the rough , the smooth , the painful , the titillatory , and so on . This fifth sense is also awakened through the vesicular extremities of fibrous filaments . Whether the grey expansion and white cords engaged in common sensation be the same as those which subserve the spinal reflex function , is a question yet undecided . This much , however , is certain : the communicated impression ascends along the posterior columns of the suinal cord , and attains a erev , vesicular centre—the ganglia of common

    sensation . Physiologists are not agreed upon the structures which fulfil this office ; they must , however , " like the other sensory ganglia , be somewhere at the base of the cranium ; and , for my own part , I am disposed to think that some portion of the cerebellum constitutes the encephalic centre of common sensation . Many years ago Foville assigned tins function to the entire organ ; and others have , with great plausibility , advocated the same notion . The anatomical connexion between the restiform bodies and certain ganglionic masses " within the cerebellum favours tho idea which I have advanced ; and there are various physiological and pathological facts and considerations which corroborate it . It is a view , moreover , which would seem to reconcile , in a great degree , the doctrine ot Gall with that of Flourens . The former , as everybody is aware , taught that the cerebellum is the organ of the sexual instinct ; and the latter , supported by most modern physiologists , states that its office is to co-ordinate muscular action , as in balancing the bod y and other such instinctive acts . Nowif some portion of the cerebellum subserve ordinary feeling , its

    in-, flKltinn ivvtnn i . l . _ £ i ! . JL T A . * . 1 * . « li . K-- / " *_« 11 * ri A / . n / lnlirnKlfl 1 Vlf"liniif : Win Jl tfl OritlOfl Ol 1113 fluenco upon the function impnted to it by Gall is conceivable , without the adoption ot his actual teaching . The facts receive another explanation . In the other view , regarding the muscular office of the cerebellum , the explanation may bo afforded by reference to the cxistonco of ita cortical grey matter , which may determine some influence to the muscles responsivel y to their feeling , it being generally held that tho muscular senso comes from their possessing common sensation , though in a less degree than tho skin . However all this may be , it is certain that thia fifth sense must have ganglia ; and it cannot ho doubted that these , through the spinal cord , arc in some sort of connexion with every sentient structuro .

    " All the sensory ganglia , it may here bo noticed , besides their instrumentality in inducing tho simpler forms of consciousness , react upon tho muscular system when stimulated from without , and that , too , in apparent independence of thought or volition . 1 no movements thus arising Dr . Carpenter very aptly designates consensual ; they are scon when the dazzled eye withdraws , instinctively , from tho light ; when tho startle follows upon a loud and unexpected sound ; and when tho young infant , from contiguity to its mother ' s bosom , exhibits restlessness , provoked by tho odour of tho mammary fluid . 1 heso muscular actions are re / lex as to their modes of occurrence ; but they differ from tho spinal reflex acts in being , in their nature , attended with consciousness ; mid they differ from ordinary movements in tho circumstance that neither ideas , nor will , nor mental emotion , properl y speaking , aro concerned in their production . u man . is much more than a sentient and instinctive animal . Sensations supply tlie primitive material for ideas , or those mental perceptions of external things and their qualities , which constitute the basis of all positive knowledge ; and which , onco in tho mind , can ho reproduced and employed in reasoning . . - i i 'The consciousness of objects , facts , and circumstances , in the reception a , nd combination of ideas , has without doubt some cerebral instrumentality for its maiiifi-Htation , am -videnco from all source *) anatomical , nhvsiolocical , and pathological , points to tho cortical

    , K"iy matter of tho brain , investing tho convolutions , as supplying tho requisite organic conditions—a Htructuro to which-has been applied , very appropriately , tho term hemispherical gangli a . "White matter intervenes between tho vosicultir nourino of tho sensory ganglia and that ° * tho cerebral convolutions : tho conscious impressions received by these former may l >« repuded as ascending along tho whit © fibres , and , on tho grey summit being attained , uevejopnig changes in its condition which minister to tho intelligence . Ideas arise . II wo reileefc upon the processes that go on within our own minds , tlicro is no difficulty in uititm-Ruitthing between a sensation nnd an idea ; or in marking tho sequential origin ot thei latter . « ow often do wo find that , when the full coiificiousnosH of flotation is obtained , tho idea « v » ggeatcd by it does not follow until many seconds , or even minutes , afterwards . You hear tho utterance of certain words , an sounds ; their signification does not otriko you ; no cllort

    of attention is made ; yet , suddenly , the sense breaks in upon your intelligence . The corv related physiological phenomena may thus be stated . The auditory ganglia take up the sentient impression at once ; its passage upwards to the region of thought is delayed ; presently , however , its natural course is freed from hindrance , and it attains the hemispherical ganglia , forming , or awakening , ideas in the mind . The anterior convolutions would appear from cranioscopic facts to be - especially concerned with those ideas and combinations of thought which flow from science and philosophy ; the superior convolutions with classes of ideas , or states of the intelligence , related to the higher sentiments , as of justice , veneration , and benevolence , and the posterior convolutions would seem to be operative in combinations of ideas and habits of thinking , referring themselves more particularly to the lower affections and propensities of our nature . " We now come to an hypothesis which is Dr . Noble ' s own , namely , that the seat of the emotions is in the optic thalami and corpora striata : —

    " But there are large masses of vesicular neurine entering into the constitution of the encephalon , of which as yet no mention has been made , and which , nevertheless , must have important functions in the display of psychical energy . There are several tracts of grey matter near the base , that have probably some connexion with particular instincts—of hunger and thirst , for example : but I allude , more especially , to the optic thalami and the corpora striata . 'lhese are gang lionic structures intimately communicating , in the ascending direction , with the cortical grey matter of the hemispheres , and , downwards , with the spinal cord ; in each case , through the medium of white fibrous substance . The office of these bodies has not been decisively made out . Physiologists differ in , their opinion , upon the question . It is most probable , however , that the optic thalami , notwithstanding their designation , have no immediate share in the production of vision . Dr . Carpenter , and some- others , think that they are most likely the ganglia of common sensation . I differ from this view , for many reasons . If wouldhowever , be tedious and out of place to argue

    , this point , at any length , upon this occasion . I have myself a strong persuasion that the structures under consideration form the ganglia of that inner sensibility , which ideas , rather than external impressions , call forth ; I regard them as the seat of the emotions . Their locality , midway as it were , between the hemispherical and the sensory ganglia ; their universal and very close connexion , by means of the central white mass of the brain , with the grey expansion of the convolutions ; and their fibrous communication with the spinal cord , constitute good anatomical reasons for the opinion of their function which I have been led to entertain . The necessity , upon psychological grounds , for separating the emotional sensibility , as evinced in grief , joy , hope , fear , pride , vanity , affection , and so on , from the sensibility of the five senses , is sufficiently obvious ; and the distinctness of these states oS consciousness from all necessary activity of the intelligence , however dependent upon ideas primarily , is very clear to the self-observer . Hence , every antecedent probability ^ would suea ^ st the speciality of nervous centres : and , as already stated , I regard the optic

    thalanu . ahd corpora striata as the organic site of all sensibility that is internal and emotional . " Inasmuch as those two masses of the brain are at present without known functions , we may expect a number of tentative guesses to be put forth before the real function be discovered . This hypothesis of Dr . Noble ' s suggesting we have already combated ( in the review of Morell ' s Elements of Psychology , where it was first broached ) as one contradicted . formally , by anatomical considerations . These bodies are structurally different ; different in anatomical connexion , different in colour , so much so that the grey corpora striata are at once distinguishable from the cafe au laitcoloured optic thalami . Todd and Bowman describing these bodies say : — " In the corpora siriata the fibrous matter is arranged in distinct fascicles of very different size matter

    many , if not all , of wjjich form a special connexion with its vesicular . In the optic thalami , on the other hand , the fibrous matter forms a very intricate interlacement , which is equally complicated at every part . " So much for structure ; and no anatomist need be told how much difference of function is involved in difference of structure . Then , again , with regard to connexion ; while they have in common an extensive connexion with the convoluted surface of the brain , they are in the most marked way connected inferiorly with separate and distinct portions of the medulla oblongata . In fact , be the functions of these bodies what they may , assuredly they are different functions . That they have anything specially to do with the emotions there is not , we believe , the shadow of a proof . of

    We have dwelt so long on these details that the main purpose Dr . Noble ' s book has been lost sight of ; that purpose was to describe insanity in its various forms and modes of treatment . Let us now turn to it . Insanity is disease of the mind—in other words , altered function of the brain . We very much prefer Dr . Noble ' s definition of " altered function to the ordinary one of a disease of the brain ; for , although strictly speaking there must be disease of the brain , there need not necessarily be lesion of the brain . It is because men confound structure with composition that so much confusion exists on this subject ; the structure of a room may remain unaltered , but if a mephitic gas takes the place of wholesome atmosphere , the composition of the room is so altered that it becomes uninhabitable . So with ihp hrnin : its structure mav be without perceptible alteration , but the blood

    which flows through it , or the state of its electricity , may be so altered as totally to destroy the function . Hence we are disposed to accept Dr . Noble ' s conclusion that the " true locality of psychological disease is withm tho head , " only as localising the function—the cause of the disturbance may be a diseased stomach or liver . He says truly enough : — ' ? But di . seaso of tho brain does not in every case provoke iimanity . There aro cerebral maladies which do not give rise to mental derangement . Simple congestion some forms ot inflammation , certain tuberculous affections , and even serous accumulations m the venticles will often oxist , without pervorting thought so as to prejudice moral liberty , btill these facts nro not in opposition to the doctrine that tho brain suhserves tho mental operations , for the exercise ot tho mind is nearly always influenced in some way or another , though insanity may not arise as a consequence of such affections ns those just cited . _ Not only so , bufc insanity is often unaccompanied by disease of the

    brain : — " No reasonable doubt can exist as to tho physical site of mental derangement , so far , at least , as concerns its relation to tho onceplialon . Yet there have been authors and practitioners who have hnd some difficulty in admitting this doctrine , owing to what they deem to bo tho want of collaboration from morbid anatomy . Tims Jacobi , Nasso , l ' lemmmg and others , hnvo been influenced by tho consideration thitf , in tho bodies of msaiio patients , anatomical lesions aro discovered moro frequently in tho viscera than in tho brain ; that , irj fact , this latter sometimes exhibits no alteration at all , whilst , on tho contrary , very decided change is apparent in tho organs of nutrition . Tho precise losion , indeed , winch the onceirimlon mistiuua in disordered mind , has not boon determined . Hut m many of our investigations , and in much of our reasoning , wo are most of us very apt to conceive that u moro ultimate correspondence cxmts between changes found in tho organs after death and tho symptoms of disease appreciable during life , than tho actual state of things warrants . MnrkB of inflammation or venous congestion , tubercles , cysts , collections of water , induration und Hoftuning of tisauo , have again and again been discovered in examination of tho dead brain , where thoro has been no insanity . Hut , Btill . according to tho statistics of establishments for treatment of tho insane , in every hundred bodies inspected after death , a state of cerebral congestion is found in twomy-livo instances ; induration of tho Btructnre of tho brain is witnessed in Homowhoro about tho minlo proportion ; and atrophy of the encephalic fiHSuo in about cloven cases . It must bo admitted that tlicro ia no form or degree of mental derangement , which has not beon known t « oxiat unnccompanicd by any physical ohtiiigCB

    December 24, 1853] T He Lea De R. 1241. ...

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• Citation
  • Leader (1850-1860), Dec. 24, 1853, page 17, in the Nineteenth-Century Serials Edition (2008; 2018) ncse-os.kdl.kcl.ac.uk/periodicals/l/issues/cld_24121853/page/17/